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Interictal High Frequency Oscillations Detected with Simultaneous Magnetoencephalography and Electroencephalography as Biomarker of Pediatric Epilepsy
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Fast ripples reflect increased excitability that primes epileptiform spikes.

Shennan A Weiss1,2,3, Itzhak Fried4, Jerome Engel4,5,6,7,8

  • 1Department of Neurology, State University of New York Downstate, Brooklyn, NY 11203, USA.

Brain Communications
|October 23, 2023
PubMed
Summary

Fast ripples, not ripples, frequently precede inter-ictal spikes in the seizure onset zone, indicating increased local excitability. These fast ripples prime spike discharges but their removal doesn't guarantee seizure freedom.

Keywords:
epileptiform spikefast ripplehigh-frequency oscillationneuronripple

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Area of Science:

  • Neuroscience
  • Epilepsy Research
  • Computational Biology

Background:

  • Neuronal circuit disturbances driving epilepsy remain unclear.
  • Understanding inter-ictal and ictal epileptiform discharges is crucial for epilepsy treatment.

Purpose of the Study:

  • Investigate the role of high-frequency oscillations in epileptiform discharge generation.
  • Determine the predictive value of pre-spike fast ripples for seizure onset zones.
  • Explore the clinical significance of fast ripples in epilepsy surgery.

Main Methods:

  • Used extra-operative macro- and micro-electrode recordings during non-rapid eye movement sleep.
  • Analyzed inter-ictal intracranial EEG spikes and associated fast ripples (200-600 Hz).
  • Correlated fast ripple occurrence and characteristics with neuronal firing and seizure onset zones in two patient cohorts.

Main Results:

  • Fast ripples, not ripples (80-200 Hz), frequently preceded inter-ictal spikes in the seizure onset zone.
  • Pre-spike fast ripples were linked to higher spectral power and more vigorous neuronal firing.
  • Sites with high pre-spike fast ripple proportion correlated with seizure onset zones, but resection did not ensure seizure freedom.

Conclusions:

  • Fast ripples preceding EEG spikes suggest increased local excitability that primes discharges in the seizure onset zone.
  • Epileptogenic brain regions are necessary but not sufficient for initiating inter-ictal epileptiform discharges.
  • Fast ripples may serve as a biomarker for seizure onset zones, but their role in seizure generation is complex.